University of Victoria, Victoria, British Columbia, Canada.
University of British Columbia, Vancouver, British Columbia, Canada.
J Med Philos. 2023 Jun 20;48(4):348-358. doi: 10.1093/jmp/jhad019.
Evidence-based medicine (EBM) has long deemphasized mechanistic reasoning and pathophysiological rationale in assessing the effectiveness of interventions. The EBM+ movement has challenged this stance, arguing that evidence of mechanisms and comparative studies should both be seen as necessary and complementary. Advocates of EBM+ provide a combination of theoretical arguments and examples of mechanistic reasoning in medical research. However, EBM+ proponents have not provided recent examples of how downplaying mechanistic reasoning resulted in worse medical results than would have occurred otherwise. Such examples are necessary to make the case that EBM+ responds to a problem in clinical practice that urgently demands a solution. In light of this, we examine the failed rollout of efavirenz as a first-line HIV treatment in Zimbabwe as evidence of the importance of mechanistic reasoning in improving clinical practice and public health policy decisions. We suggest that this case is analogous to examples commonly given to support EBM.
循证医学（EBM）长期以来在评估干预措施的有效性时，都不重视机械推理和病理生理学原理。EBM+运动对这一立场提出了挑战，认为机制证据和比较研究都应该被视为必要且互补的。EBM+的倡导者提供了理论论证和医学研究中机械推理的例子的组合。然而，EBM+的支持者并没有提供最近的例子来说明轻视机械推理如何导致比其他情况更糟糕的医疗结果。这些例子是必要的，以使 EBM+回应临床实践中迫切需要解决的问题。有鉴于此，我们考察了在津巴布韦将依非韦伦作为一线 HIV 治疗方案的失败，以此证明机械推理在改善临床实践和公共卫生政策决策方面的重要性。我们认为，这种情况类似于支持 EBM 的常见例子。
